Gastrectomy

What is a gastrectomy?

A gastrectomy is a surgery that removes all or part of your stomach. Your stomach is your digestive system’s food reservoir. It allows you to store and break down the food you eat before it travels to your small intestine, which absorbs nutrients.

But if you develop a condition like stomach (gastric) cancer, your stomach can cause more harm than good. In that case, you may need a gastrectomy. Although a gastrectomy changes your digestive system, you can live (and eat) without a stomach.

There are two main types of gastrectomy:

• Total gastrectomy removes your entire stomach.
• Partial gastrectomy includes several surgery types that remove part of your stomach. The procedure names vary based on how much stomach tissue gets removed. For example, a subtotal gastrectomy removes about 80% of your stomach. Some types are classified based on their purpose. For example, gastric sleeve surgery is a partial gastrectomy that treats severe (Class III) obesity.

What does gastrectomy treat?

Gastrectomy most commonly treats stomach cancer. You may need a total or partial gastrectomy to cure the cancer (eliminate it) or prevent it from spreading. Gastrectomy can also be palliative when the cancer isn’t curable. This means the surgery relieves cancer symptoms, like stomach bleeding and pain.

Healthcare providers sometimes use gastrectomy to treat other conditions. It may be a last resort when less invasive treatments like medicine and lifestyle changes haven’t helped enough.

Gastrectomy treats:

• Benign stomach tumors. Tumors that cause symptoms or may become cancerous may need to be removed.
• Gastritis. In rare cases, inflammation in your stomach lining can cause severe symptoms that medication can’t improve. You may need surgery.
• Peptic ulcer disease. You may need surgery to treat stomach sores and ulcers that can damage your stomach lining.
• Obesity. Your healthcare provider may recommend partial gastrectomy as a type of bariatric (weight loss) surgery if you have obesity that’s harming your health.
• Injuries. You may need parts of your stomach removed if an injury has damaged the tissue beyond repair.

You may choose to have your stomach removed to prevent hereditary diffuse stomach cancer. You’re at high risk of developing this cancer if you inherit a mutation (error) in a gene called CDH1 from a biological parent. This cancer is nearly impossible to detect early when treatments work best. If you have this mutation, your healthcare provider may recommend total gastrectomy.

How should I prepare for a gastrectomy?

• Review your medical history with your provider. Your healthcare provider will ensure you’re a good candidate for surgery. They’ll review your medical history and ask about all medicines, vitamins, herbs and supplements you’re taking. They’ll ask about allergies and your previous response to anesthesia.
• Adjust your diet and exercise as needed. You may need to change your diet and exercise regimen to get in the best shape possible for surgery. Follow your provider’s guidance to get healthier.
• Stop using tobacco. You’ll need to quit several weeks before surgery if you smoke or chew tobacco. Studies have shown that quitting smoking improves surgery outcomes in people with stomach cancer.
• Adjust medications as needed. You may need to stop using certain medicines that can thin your blood, like nonsteroidal anti-inflammatory medicines (NSAIDs), aspirin and warfarin (Coumadin®). Your provider will review your medicines to ensure you know what to stop or continue taking to be safe for surgery.
• Follow fasting instructions. You may need to stop eating or drinking before surgery. Follow your provider’s instructions about what (and how much) is safe to consume.
• Arrange for a ride from the hospital. You’ll need someone to drive you home from the hospital.
• Prepare your home. Relocate essential objects so they’re easy to reach, and so you don’t have to do any heavy lifting post-surgery. If possible, have someone stay with you to help during recovery. Ask your healthcare provider what type of live-in help you may need and for how long.

What happens when you have a gastrectomy?

During surgery, your surgeon removes all or parts of your stomach. They reconstruct your digestive system so you can continue to receive nourishment.

Your healthcare provider will:

1. Administer anesthesia. You’ll get medicine through an IV (a vein) that will put you to sleep for the operation. You won’t feel any pain or be aware of what’s happening.
2. Place necessary catheters. You may need a catheter to collect your urine (pee). The catheter goes inside your bladder and drains your urine. You may also need a nasogastric tube. This tube goes through your nose and into your stomach. It suctions out stomach contents. Afterward, a provider may use this tube to give medicine and nutrients.
3. Remove all or part of your stomach using open surgery or laparoscopy. With open surgery, your surgeon makes a single large cut that allows them to remove your stomach. Laparoscopy involves several small cuts. Your surgeon inserts a lighted instrument with a camera (laparoscope) into one cut so they can view your organs. They perform surgery through other cuts. If you have stomach cancer, they may also remove lymph nodes (lymphadenectomy) to see if cancer has spread there.
4. Reconstruct your digestive system. Your surgeon will attach the remaining organs so your digestive system still works. For example, if they remove part of your stomach, they’ll attach your small intestine to the remaining parts of your stomach. If they remove your entire stomach, they’ll attach your small intestine to your esophagus. They may insert a feeding tube directly into your stomach or small intestine to help you eat during recovery.
5. Suture the cut. They’ll stitch the cut or cuts.

How long does a gastrectomy take?

It can take up to five hours, depending on the type of gastrectomy and whether it’s open surgery or laparoscopy. It’s a major operation that requires lots of time and care on the part of your care team.

What happens after a gastrectomy?

You’ll need to remain in the hospital for up to two weeks so your healthcare team can monitor you. They’ll ensure you’re getting the nutrition you need. They’ll also ease you into eating solid foods. They’ll work with you to monitor your pain levels and provide pain medicines as needed.

While everyone’s journey is different, you can expect some typical phases as you start recovering in the hospital:

• You’ll receive food or drink through an IV or a catheter in your belly as your wound heals.
• You’ll progress to a liquid diet that you take by mouth. Your healthcare provider may perform tests beforehand to ensure your digestive system works correctly.
• You’ll progress to a soft diet and eventually transition to light meals.

Your care team will also advise you on wound care. For example, you may need to stick to sponge baths instead of baths or showers until your wound heals.

What are the benefits of this procedure?

A gastrectomy can be a lifesaving procedure that cures or slows the spread of stomach cancer. When used as bariatric surgery, it can prevent potentially life-threatening complications associated with Class III obesity. It can also improve your quality of life by eliminating symptoms.

What are the risks or complications of a gastrectomy?

As with any surgery, complications include infection, being allergic to anesthesia and blood clots. You may need to wear compression socks after surgery to reduce your risk of clotting.

Complications unique to gastrectomy include:

• Afferent and efferent loop (limb) syndrome. When digestive juices that need to flow freely to help you break down food get trapped in your small intestine. It can cause symptoms like abdominal pain, nausea and vomiting.
• Anastomotic leak. When there’s a leak at the new attachment sites.
• Bile reflux. When bile, a substance your liver makes to digest fats, flows backward into your stomach or esophagus. The bile can break down the protective lining of your esophagus and stomach.
• Dumping syndrome. When food travels to your small intestine before it’s been broken down enough. This can cause unpleasant symptoms, including nausea, bloating, pain and diarrhea.
• Malnutrition. When you’re not getting enough of the right nutrients. Many people lose around 10% of their body weight in the first few months after surgery. Lack of nutrients can lead to other conditions, like anemia.
• Internal hernia. When parts of your small intestine bulge through the membrane that attaches your intestine to your abdominal wall. A hernia can feel like pressure or pain in your abdomen. Internal hernias may require emergency treatment.
• Narrowing at the attachment site. When the site that connects your partial stomach or esophagus and small intestine narrows. This can cause a bowel obstruction that makes it harder to poop.
• Post-surgery gastroparesis. When your stomach doesn’t process food as quickly as it should. This can cause symptoms like bloating, nausea and vomiting, and indigestion.

Tell your healthcare provider about any complications you’re experiencing. It’s important to attend all follow-up appointments so they can ensure you’re healing without issues.

What is the recovery time?

Gastrectomy is a major surgery that requires months — not weeks — to heal. It may take up to two months to heal from the surgery. Regaining your energy levels and getting used to your new eating habits may take three to six months or even longer. Be patient with yourself as your body repairs itself and adjusts to the changes in your digestive system.

When can I resume driving?

It may take a month or more before you can safely drive yourself. Ask your healthcare provider what’s safe for you.

When can I go back to work?

Plan to take several weeks or even a few months off work, depending on your job type. Some people work remotely at first before returning to the office. Others resume part-time work before transitioning to full-time. Ask your healthcare provider what to expect based on your situation.

Can you live a normal life after gastrectomy?

You can live a healthy, normal life without a stomach. Still, you’ll have to find a new normal regarding the types of food you eat and how often you eat. Foods you ate before without issues may make you feel sick after a gastrectomy. You’ll likely need to find a new balance to ensure you get enough nutrients — without eating so much that you’re straining your digestive system.

Here are some tips to help you transition into your new normal post-surgery:

• Get as much rest as you need. Take naps and go to bed early if you’re feeling exhausted. Your body needs the rest.
• Increase your meal frequency but decrease your portions. Instead of eating three large meals a day, eat six smaller meals. You may need to drink before or after meals instead of while you’re eating.
• Adjust what you eat. Some foods may be difficult to tolerate in the beginning. For example, foods high in fiber (like oats, rice, pasta and whole-grain bread) may be hard for your digestive system to process. Some people struggle with dairy after gastrectomy and become lactose intolerant. Take note of how different foods affect your digestive system. Learn what foods keep you feeling nourished and full.
• Take vitamins and supplements as needed. Your body may be unable to absorb key nutrients after your gastrectomy. You may need to take vitamins or supplements to prevent malnourishment. For example, you may need to take vitamin B12, which can be especially challenging to digest without a stomach.
• Don’t overexert yourself (but keep moving). You’ll need to take it easy as you heal, but you don’t want to stop moving completely. Light exercise, like short walks, can prevent complications like blood clots. Although it may take some time, eventually, you may be able to return to regular exercise. Follow your healthcare provider’s guidance on what activities are safe.

When should I call my healthcare provider?

Keep all follow-up appointments with your healthcare provider so they can ensure you’re healing as you should. In the meantime, alert your provider if you’re experiencing new symptoms or if any of the following symptoms are worsening:

• Nausea and vomiting.
• Diarrhea.
• Soft stools (stools should gradually get firmer).
• Pain, pressure or bloating in your belly.

See your provider if you’re noticing signs of an infection like a fever or any of the following at the surgical site:

• Redness.
• Swelling.
• Warmth.
• Pus.